Prostate cancer

Question 1

Function of the prostate

Answer 1

Makes seminal fluid that is stored in the seminal vesicles

Question 2

Linked to what cancer in mother/sister?

Answer 2

Breast (BRCA link)

Question 3

Who can request a PSA?

Answer 3

Men >50

Question 4

5 signs of metastatic disease?

Answer 4

Anaemia

Lymphoedema

Malaise

Bone pain

Wt loss

Question 5

What investigation is done at urology?

Answer 5

MRI guided transrectal biopsy

Question 6

Risk with transrectal biopsy?

Answer 6

Bacteriaemia and death

Question 7

Grading score used

Answer 7

Gleason score

Question 8

How does gleason score work?

Answer 8

Look at biopsies

The cells present could be graded 1-5

1 and 2 ignored

The two most common tissue types are taken and used as two numbers to give the score.

e.g. if all were 3 then 3+3=6. If mostly 4, some 3 and a few 5 then 4+3=7

Question 9

What are the best and worst gleason scores? How are they categorised?

Answer 9

6 lowest, 10 highest

6=low risk

7= intermediate risk

8-10 = aggressive

Question 10

How is prostate cancer staged?

Answer 10

TNM

Question 11

What is T1-4 in staging?

Answer 11

T1- biopsy only

T2- in prostate

T3- breaching capsule

T4- into rectum/bladder

Question 12

How is overall risk done?

Answer 12

Combine gleason score, T (of TNM) and PSA

Low/int/high risk

Low risk- gleason <6, T 1c/2a, PSA <10

Intermediate risk- gleason 7, T2b/c, PSA 10-20

High risk- gleason >/=8, PSA>/=20

Question 13

What is TX

Answer 13

The primary tumour cannot be evaluated.

Question 14

At what stage would a tumour be felt on PR?

Answer 14

> T2

Question 15

At what stage would a tumour be felt on PR?

Answer 15

> T2

Question 16

What makes the cancer >/= T2b?

Answer 16

Involves more than half of 1 side of the prostate

Question 17

Management options (local)

Answer 17

Robotic laparoscopic prostatectomy

RT

Brachytherapy

Active monitoring

Watchful waiting

Question 18

Drawbacks of prostatectomy?

Answer 18

Risk impotence and incontinence

Infertile afterwards but can store sperm

Question 19

How likely is it that a man might get impotence after prostatectomy?

Answer 19

Before having any treatment, 67% of men said they could get erections firm enough for intercourse. When the men who had a radical prostatectomy were asked again after 6 months, this had decreased to 12%. When asked again after 6 years, it had slightly improved to 17%.

Question 20

How likely is it that a man might get urinary incontinence after prostatectomy?

Answer 20

1% of men said they used absorbent pads before having any treatment. When the men who had a radical prostatectomy were asked again after 6 months, this had increased to 46%. After 6 years, this had improved to 17%.

Question 21

How likely is prostatectomy to cure the cancer?

Answer 21

For around 1 in 3 men, the cancer cells may not be fully removed and may return some time after the operation.

Question 22

what must men do to prepare for their RT treatment each time?

Answer 22

Enema first and have a full bladder to minimise bladder and bowel damage and ensure prostate in same position.

Only actually takes 2-3 mins

Question 23

Who is RT good for?

Answer 23

Older/co-morbs

Question 24

what is the risk with RT

Answer 24

LT bowel probs

Question 25

Who is brachytherapy good for

Answer 25

Fit, no-comorbs

Question 26

Who should avoid brachytherapy?

Answer 26

Large prostate/significant urinary sx

Question 27

How is brachytherapy done

Answer 27

US probe in rectum GA 4 hours Through perineum deliver radiation ± insert radioactive seeds

Question 28

SE brachytherapy?

Answer 28

Significant urinary SEs (temporary)

Question 29

Temporary SEs RT?

Answer 29

Diarrhoea Soreness in the area Loss of pubic hair Tired Cystitis

Question 30

RT impotence stats?

Answer 30

67% of men said they could get erections firm enough for intercourse, decreasing to 22% after 6 months. Although this improved over the next 6 months, when asked again after 6 years, it had declined again to 27%.

Question 31

RT likelihood of it returning?

Answer 31

1/3 same as prostatectomy

Question 32

How do the brachytherapy SEs compare with RT?

Answer 32

the risk of urinary problems is higher the risk of sexual dysfunction is the same. The risk of bowel problems is slightly lower.

Question 33

What is involved with active monitoring?

Answer 33

MRI annually, if change then biopsy ± ?treat, if not continue to monitor

Question 34

What is watchful waiting and who gets it

Answer 34

Older men with co-morbs who you think will die of something else No radical treatment Maybe sx control

Question 35

Advanced treatment options?

Answer 35

Androgen deprivation therapy - 1. antiandrogen therapy, 2. chemical castration, 3. orchidectomy Other systemic drugs (chemo or other) Pallative RT for bone pain

Question 36

What does anti androgen therapy do?

Answer 36

Prevents testosterone binding to receptors e.g. flutamide

Question 37

What is chemical castration

Answer 37

GnRH analogue- inhibits formation of LH in pituitary e.g. leuprorelin

Question 38

SEs anti androgens

Answer 38

Hot flushes Decrease sexual function/shrink genitals Decreased muscle bulk and strength Memory or mood disturbance 10% wt gain (central) --> risk DM Osteoporosis and fracture risk ?CV risk

Question 39

Where is prostate ca likely to spread?

Answer 39

Lymph and bones

Question 40

Histological type of prostate ca?

Answer 40

Adenocarcinoma